#MayoClinicNeuroChat about Brain Aneurysms

Wed, Feb 8, 2017
1:00pm to 2:00pm ET

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Dr. W. David Freeman, neurologist, and Dr. Rabih Tawk, endovascular neurosurgeon talk about brain aneurysms.

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@abissol41

My husband had a rupture in January 2013. He had a coiling then that saved his life. 6 months later at a followup angiogram we learned he needed a clip which he had done in Sept 2013. He was a smoker and high BP. He currently still takes bp meds but recently started smoking again. What are the chances this new/old habit will cause a problem for his aneurysm?

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Hi @abissol41. I sent your question to Dr. Freeman and this is his response:

“This is a great question. He needs to quit smoking to reduce his risk of future aneurysms and there is not a good number we can cite for his particular aneurysm future risk without knowing if he has any residual risk factors as studied. Also, smoking turns on genes we now know that change the risk. Therefore, he needs to seek a smoking cessation program. There are now teams at Mayo Clinic in smoking cessation with medications, acupuncture, counseling etc that can help him. Mayo has an integrated smoking cessation program. Besides brain aneurysm, smoking cessation can help his other health including reducing the future risk of lung cancer, lung disease (e.g., COPD, emphysema), and cardiac disease like heart attack and ischemic stroke. Not to mention, quitting smoking can help him save money given the high price of cigarettes! Therefore, we as doctors cannot underscore that message enough since it sounds like he has already had brain aneurysms successfully and could prevent future problems from something so simple and effective. In the words of Benjamin Franklin “An ounce of prevention is worth a POUND of cure.” Smoking and aneurysms increases his risk of future aneurysm rupture or future aneurysm development (unruptured by 1.7-2X) the normal patient.” https://www.ncbi.nlm.nih.gov/pubmed/10478344

Liked by ladycat

That is Sean Bretz’s Birthday and he will be 29! Thanks to Drs Tawk and Freeman for giving Sean the gift of
Iife and “Saving the life of a Lifesaver” Myself and family will always be grateful! Noel Bretz

I had a giant aneurysm in the cavernous sinus treated with 4 pipeline stents. I had pain for a year before the surgery as the aneurysm was pressing on trigeminal nerve. This was 8 years ago and have had constant pain from both trigeminal and occipital neuralgia and my pain DR says I have central pain/ post stroke pain? 2 months after surgery I got severe burning pain in both knees and over past 8 years it has spread to my feet and hips and is equal on both sides. Location of the aneurysm and the complicated surgery are cause he says, the last of the 4 stents wouldn’t open and they spent over two hours trying to open the stent with every option available including balloons and may have damaged other areas and nerves in cavernous sinus including thalamus?. The cavernous sinus is where all the trauma started and he said that is why I have all the pain still 8 years later and it has spread to lower body. Any thoughts on surgery in cavernous sinus and central pain? Was told that no Dr. would ever do normal surgery there due to complications and the stent was only option. 24/7 head pain and lower body too, not much of a life.

Liked by ladycat

Am praying you meet the right doctor to help this situation. Please don’t give up. I hope all reading this will have some valid suggestions!

Liked by ladycat, rhibbing

Hi Dr Tawk and Freeman. Just wanted to let u know that today February 8 is Sean Bretz’s birthday. He would not be here celebrating this day without you both and the Mayo Clinc. Thanks to all. Kate

Will my husband’s libido ever return to normal? Are the post aneurysm personality changes permanent?

@byhisgrace

Will my husband’s libido ever return to normal? Are the post aneurysm personality changes permanent?

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Hi @byhisgrace, you may have seen the video where Dr. Tawk and Dr. Freeman addressed this question at the 24:30 mark. I’ll summarize: “We know that aneurysms can affect hormones. The pituitary gland can be affected. Testosterone levels can affect libido. Sleep, social integration, and other common issues can be affected. If there is scarring or injury in the front part of the brain, personality can be affected. This can also cause poor sleep and depression. These are simple issues to screen for and treat.

Liked by ladycat

@rhibbing

I had a giant aneurysm in the cavernous sinus treated with 4 pipeline stents. I had pain for a year before the surgery as the aneurysm was pressing on trigeminal nerve. This was 8 years ago and have had constant pain from both trigeminal and occipital neuralgia and my pain DR says I have central pain/ post stroke pain? 2 months after surgery I got severe burning pain in both knees and over past 8 years it has spread to my feet and hips and is equal on both sides. Location of the aneurysm and the complicated surgery are cause he says, the last of the 4 stents wouldn’t open and they spent over two hours trying to open the stent with every option available including balloons and may have damaged other areas and nerves in cavernous sinus including thalamus?. The cavernous sinus is where all the trauma started and he said that is why I have all the pain still 8 years later and it has spread to lower body. Any thoughts on surgery in cavernous sinus and central pain? Was told that no Dr. would ever do normal surgery there due to complications and the stent was only option. 24/7 head pain and lower body too, not much of a life.

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@rhibbing Your questions are very specific to your situation. Should you wish to get a second opinion from Mayo Clinic experts, please contact one of our 3 campuses in AZ, FL or MN. The contact information can be found here: http://mayocl.in/1mtmR63

Liked by ladycat

I am 38 year old, no high blood pressure, no smoking ever, no alcohol ever, i have good health, no family history of aneurysms, I have been diagnosed with 3 brain aneurysms towards the back of my brain 2 weeks ago, 1 with 4mm size, 2nd one 3mm size and third one 2mm size. I have been to John Hopkins to the world renowned doctor Alexander Coon, he has scheduled me for cerebral angiography on 17th May 2017. He also mentioned to me that he will most probably perform 2 surgeries(1 to 2 weeks apart ) with Pipeline Embolization Device which is a flow diverting latest device. I am also trying to get 2nd and third opinions. some doctors are saying to wait and observe since they are small. Can anyone please tell me if they have similar size aneurysms as mine they are also put on wait and observe and what did their neurosurgeons recommend and/or did you also get any second or third opinions, if you could please share with me so that I am well informed to make decisions. I have been reading about the post surgery effects such as sever headaches, fatigue, stroke risk, groin pain, possible hair loss, low back pain, depression etc. I am living a normal healthy life and it doesn’t make sense for me to have 2 surgeries, I would want to wait and observe

here are my 3 brain aneurysms report
1. 3 x 4 x 3 mm saccular aneurysm arising from the medial wall of the left cavernous ICA.
2. 3 mm saccular aneurysm arising from the medial wall of the left supraclinoid ICA.
3. 2mm saccular aneurysm arising from the medial wall of the right paraclinoid ICA.

Welcome to Connect, uroojkamran.
If you would like to get a second opinion from Mayo Clinic experts, please contact us at one of our campuses. You’ll find the contact information here: http://mayocl.in/1mtmR63

I’m bringing @ladycat and @kariulrich into this discussion too.

@uroojkamran

I am 38 year old, no high blood pressure, no smoking ever, no alcohol ever, i have good health, no family history of aneurysms, I have been diagnosed with 3 brain aneurysms towards the back of my brain 2 weeks ago, 1 with 4mm size, 2nd one 3mm size and third one 2mm size. I have been to John Hopkins to the world renowned doctor Alexander Coon, he has scheduled me for cerebral angiography on 17th May 2017. He also mentioned to me that he will most probably perform 2 surgeries(1 to 2 weeks apart ) with Pipeline Embolization Device which is a flow diverting latest device. I am also trying to get 2nd and third opinions. some doctors are saying to wait and observe since they are small. Can anyone please tell me if they have similar size aneurysms as mine they are also put on wait and observe and what did their neurosurgeons recommend and/or did you also get any second or third opinions, if you could please share with me so that I am well informed to make decisions. I have been reading about the post surgery effects such as sever headaches, fatigue, stroke risk, groin pain, possible hair loss, low back pain, depression etc. I am living a normal healthy life and it doesn’t make sense for me to have 2 surgeries, I would want to wait and observe

here are my 3 brain aneurysms report
1. 3 x 4 x 3 mm saccular aneurysm arising from the medial wall of the left cavernous ICA.
2. 3 mm saccular aneurysm arising from the medial wall of the left supraclinoid ICA.
3. 2mm saccular aneurysm arising from the medial wall of the right paraclinoid ICA.

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I would try to gather as much information as possoble and seek as many opinions as you need to feel you are making the best decision. This is new for you so im sure you are so overwhelmed right now. My husband had a ruptured aneurysm at 33, as i was 6 month pregnant with our 2nd child. My prosepctive on it is if you wait, it may be something that ends up causing u much anxiety with the what ifs. What if it ruptures? As a young person the residual risks are much worse than risks of repair to unruptured aneurysm. At least by seeking other opinions you get all the info and can weigh things for yourself. Just for us, i wish we would have known about my husbands earlier. How did u find out? Generally they are. Ot noticed on regular MRIs

My aneurysms are monitored due to their small size (2mm) I am very comfortable with that plan. I know what symptoms to watch. They have been stable over he past decade however I have developed a AVM which we are adding to the list to watch. Gather as much information as you can, and make a decision based on your comfort level. It sounds like you are in great hands! Your situation is very different than min, in that you have multiple aneurysms that are treatable. Make sure you get every question answered. I recommend keeping a note book, you never know when a thought or question will pop through your head! Let us know how you are doing!

I am new to connect. I hope this is the right way to add to the discussions. I am 4 weeks post op coiling and pipeline stent for a posterior communicating artery 2 cm aneurysm. Dr. Lansino’s team performed my surgery with no operative complications. PTL. But I have had headaches every day since surgery- in my riight eye area and my temple. Worse at night. I am so tired most of the time as well. I wonder how long these headaches will continue? And what therapies are offered or used by others with this same problem. There seems to be general recognition that
Headaches after this surgery are common- but little recommendations as to treatment. Has anyone tried Gabapentin or nortriptyline or other medical treatments? I would very much appreciate any suggestions or information you all might offer.
JEH100

@jeh100

I am new to connect. I hope this is the right way to add to the discussions. I am 4 weeks post op coiling and pipeline stent for a posterior communicating artery 2 cm aneurysm. Dr. Lansino’s team performed my surgery with no operative complications. PTL. But I have had headaches every day since surgery- in my riight eye area and my temple. Worse at night. I am so tired most of the time as well. I wonder how long these headaches will continue? And what therapies are offered or used by others with this same problem. There seems to be general recognition that
Headaches after this surgery are common- but little recommendations as to treatment. Has anyone tried Gabapentin or nortriptyline or other medical treatments? I would very much appreciate any suggestions or information you all might offer.
JEH100

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I wanted to add that my aneurysm was found unruptured by MRA done for dizziness. Otherwise I had no Neuro symptoms. Thank you.

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